title: Concomitant anal and cervical human papillomavirusV infections and intraepithelial neoplasia in HIV-infected and uninfected women.
abstract: OBJECTIVE
  To assess factors associated with concomitant anal and cervical human papillomavirus (HPV) infections in HIV-infected and at-risk women.
  
  
  METHODS
  A study nested within the Women's Interagency HIV Study (WIHS), a multicenter longitudinal study of HIV-1 infection in women conducted in six centers within the United States.
  
  
  METHODS
  Four hundred and seventy HIV-infected and 185 HIV-uninfected WIHS participants were interviewed and examined with anal and cervical cytology testing. Exfoliated cervical and anal specimens were assessed for HPV using PCR and type-specific HPV testing. Women with abnormal cytologic results had colposcopy or anoscopy-guided biopsy of visible lesions. Logistic regression analyses were performed and odds ratios (ORs) measured the association for concomitant anal and cervical HPV infection.
  
  
  RESULTS
  One hundred and sixty-three (42%) HIV-infected women had detectable anal and cervical HPV infection compared with 12 (8%) of the HIV-uninfected women (P  <  0.001). HIV-infected women were more likely to have the same human papillomavirus (HPV) genotype in the anus and cervix than HIV-uninfected women (18 vs. 3%, P  < 0.001). This was true for both oncogenic (9 vs. 2%, P  =  0.003) and nononcogenic (12 vs. 1%, P < 0.001) HPV types. In multivariable analysis, the strongest factor associated with both oncogenic and nononcogenic concomitant HPV infection was being HIV-infected (OR = 4.6 and OR  = 16.9, respectively). In multivariable analysis of HIV-infected women, CD4 cell count of less than 200 was the strongest factor associated with concomitant oncogenic (OR  = 4.2) and nononcogenic (OR  =  16.5) HPV infection.
  
  
  CONCLUSIONS
  HIV-infected women, particularly those women with low CD4 cell counts, may be good candidates for HPV screening and monitoring for both cervical and anal disease.
authors.affiliation: Department of Clinical Pharmacy, University of California, San Francisco, California 94143-0613, USA. Nancy.Hessol@ucsf.edu
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Hessol
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Holly
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Weber
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002278:Carcinoma in Situ / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D016133:Polymerase Chain Reaction; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000821:virology